Summary: Neurological illnesses such as Parkinson’s disease, dementia and epilepsy do more than alter physical function; they can erode memory, communication and the sense of who a person is. A new paper argues that because these conditions attack the core of identity, routine spiritual assessment and care should be integrated into neurological practice.
The authors recommend a “biopsychosocial-spiritual” approach that extends conventional medical care to include patients’ existential concerns, meaning-making, and spiritual resources—dimensions that influence coping, treatment decisions, and quality of life.
Key Facts
- The Identity Impact: Neurological diseases uniquely affect elements that define identity—memory, movement and communication—so spiritual beliefs and values often become essential tools for resilience and decision-making.
- The 60% Gap: Research shows that about 60% of adults want their spiritual or religious concerns acknowledged in medical settings, yet many clinicians avoid the topic due to limited training, time pressures, or discomfort.
- The FICA Framework: The paper endorses the FICA tool (Faith, Importance, Community, Address) as a concise, structured method for taking a spiritual history that can be used in routine neurology visits.
- Spiritual Generalists: Neurologists are encouraged to act as “spiritual generalists”—recognizing spiritual distress, validating patients’ beliefs, and referring to chaplains, therapists, or faith leaders when specialized support is needed.
- Clinician Well-being: Integrating spiritual care can benefit clinicians as well, correlating with lower burnout and greater professional satisfaction when physicians feel they are treating the whole person.
Source: UCLA
People living with neurological disease often face profound questions about identity, purpose and meaning in addition to physical decline. Yet the clinicians best positioned to address these concerns—neurologists—rarely receive training or practical tools to assess spiritual needs, the authors contend.
Published in Neurology Clinical Practice and authored by researchers at UCLA Health, the University of Colorado, Harvard Medical School and Brown University, the paper provides practical recommendations to make spiritual assessment a feasible part of neurologic care.
The paper explains why neurologists are especially well placed to engage patients about spirituality and why avoiding the subject can leave an important part of patient care unaddressed.
“Neurologic diseases attack the very things that define who we are: our memory, our movement, our ability to communicate,” said lead author Dr. Indu Subramanian, a movement disorders neurologist at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System.
“In that context, a patient’s spirituality isn’t peripheral to their medical care. It’s often central to how they cope, find meaning and make decisions about treatment.”
Studies cited in the paper indicate that many patients want clinicians to acknowledge spiritual concerns, yet clinicians frequently refrain from asking. The authors link this gap to missed opportunities for improved coping, stronger patient-clinician relationships, and better alignment of care with patients’ values—especially important for progressive conditions that alter identity over time.
The paper builds on the biopsychosocial-spiritual model, which recognizes spirituality as a distinct, measurable domain alongside biological, psychological and social factors. Major medical organizations increasingly endorse this broader framework as relevant to comprehensive neurological care.
Simple tools for a sensitive conversation
A practical contribution of the paper is guidance on how neurologists can screen for spiritual concerns without significantly extending visit time. The authors recommend an initial, two-question screen that takes under two minutes: ask whether spirituality or faith is important to the patient’s health-related thinking, and whether they have or would like someone to talk with about those concerns.
For clinicians who prefer a more open-ended approach, suggested prompts include, “What do I need to know about you as a person to give you the best care possible?” or “From where do you draw your strength?” The FICA framework (Faith, Importance, Community, Address) is provided for clinicians who want a slightly deeper but still structured spiritual history.
The authors also list verbal cues that may indicate unaddressed spiritual distress—questions such as “Why is this happening to me?” or statements like “I’ve lost touch with my faith since this diagnosis.” Identifying these signals can guide timely referral to chaplains, mental health professionals or community supports.
Subramanian stresses that neurologists do not need to serve as spiritual counselors. Instead, acting as “spiritual generalists” means recognizing and validating spiritual needs, asking simple screening questions, and referring patients to appropriate resources when necessary.
A patient’s perspective
Co-author Kirk Hall, who lives with Parkinson’s disease, describes faith as central to how he navigates his diagnosis. “It has not escaped me that this is a gift from God, even if I don’t necessarily agree with His choice of gift wrap,” Hall writes. “Our belief that we will be equipped to deal with whatever happens is extremely comforting to us.” His experience highlights how spirituality can be foundational to resilience rather than merely supplementary to medical care.
Benefits for clinicians
The paper also emphasizes benefits for clinicians who incorporate spiritual care into practice. Evidence cited associates spiritual care training with reduced burnout, lower work-related stress and improved physician well-being. Attending to patients’ spiritual and existential needs may help neurologists derive greater meaning from their work and provide more person-centered care.
Key Questions Answered:
A: Because the brain is central to identity. When conditions like Parkinson’s or dementia change how you move, think, or communicate, patients often ask, “Who am I now?” or “Why is this happening?” Addressing spiritual and existential concerns helps clinicians treat the whole person, not just physical symptoms, and supports patients’ ability to cope and make treatment decisions.
A: Not necessarily. A brief screen can take less than two minutes. A focused question like, “From where do you draw your strength?” can yield insights into a patient’s resilience that inform care more effectively than adding lengthy assessments.
A: In clinical practice, “spirituality” is broader than organized religion. It encompasses what gives a person meaning, purpose and connection. Even secular patients can experience spiritual distress—loss of purpose, hopelessness or a fractured sense of self—that affects mental health and recovery, and that clinicians should be prepared to address.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The cited journal paper was reviewed in full.
- Additional context and clarification were provided by the editorial staff.
About this neuroscience and neuroethics research news
Author: Will Houston
Source: UCLA
Contact: Will Houston – UCLA
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Spiritual Assessment of Neurologic Patients” by Indu Subramanian, Christina L. Vaughan, John R. Peteet, Kirk Hall, and W. Curt LaFrance Jr., Neurology Clinical Practice
DOI: 10.1212/CPJ.0000000000200591
Abstract
Spiritual Assessment of Neurologic Patients
Background
Holistic well-being is central to quality health care and includes not just medical and psychological care but also attention to spirituality. For people living with neurologic disease, spirituality often contributes importantly to meaning-making and coping amid uncertainty and progressive change.
Recent Findings
While spirituality can support patients through disability, transitions and terminal illness, it is frequently addressed only during crisis and often deferred to chaplaincy or palliative teams that may not know the patient well. Research indicates patients commonly welcome clinicians asking about spirituality, but clinicians often hesitate.
Implications for Practice
Because spiritual support is associated with improved outcomes and greater patient satisfaction, spiritual screening is an important skill for neurologists practicing person-centered care. Yet training in these skills is rarely included in standard neurology education. The authors recommend brief screening techniques, the FICA framework for deeper inquiry, and clear referral pathways so spiritual care can be integrated practicably into neurology clinics.